Profitable Health Care

WHY do the defenders of medicare always point to the United States to scare Canadians off discussions about an expansion of private health care in Canada? The two countries’ systems of health care are like night and day. I don’t know any Canadian advocating to provide medicare to the destitute alone as the U.S. does.

Unfortunately, in Canada, people love to equate two-tier health care with the American model.

Slowly, people are recognizing two-tier health has been in Canada for decades, perhaps forever — you know when Jack Layton admits it to be so, it’s got to be gaining acceptance, at least among those not running to be prime minister.

So why the fear and loathing of private health clinics and hospitals?

I have loads of respect for Noralou Roos. She’s a great lunch date and an eminent health researcher. She is Manitoba’s own. In fact, she has the Order of Canada; I have won no awards, although I am a member of the Order of the Buffalo Hunt. (No, really). But she and I disagree on the merits and dangers of opening Canada’s medicare system up to some competition or help, as I would characterize it, from the private sector.

We disagree about the usefulness of private clinics, such as the one Mark Godley has brought to Manitoba, but which has been hamstrung by a provincial government decidedly hostile to the idea of private health care. Hostile to the point of making it illegal for private clinics to offer publicly insured services, unless with the imprimatur of the minister himself.

But Noralou Roos and her colleagues, writing on this page, are urging the minister to charge Godley if he dares to serve a Manitoban with an MRI or a hip replacement, for example.

Personally, I can’t wait for this tiff between Godley and Health Minister Tim Sale to get legal — my bets are on Godley. Imagine defending the power to decide when sick people will get treated and where. Oh wait, that fight’s been fought already. At the Supreme Court of Canada, last summer. Medicare’s monopoly lost.

Manitobans know why. Especially those waiting many months to be relieved of pain. And there’s those who keep Godley in business and the doctors and the 50 or so nurses he’s got on his roster — who also work in the hospitals and the like.

Canadians have ample experience in dealing with private health care — to the tune of $32 billion in spending every year. Even Prof. Raisa Deber’s research paper, prepared for the Romanow Commission in 2002, found mixed results from the attempts to measure the good and the bad of private-for-profits versus not-for-profits. She found it’s difficult to compare them. She notes private operations make money by charging for extras and cutting costs. That’s called private enterprise. I don’t care if the nurse or technician on my case is unionized and taking 15-minute breaks on schedule. I care that they know what they’re doing.

They also make money by offering patients speedy service. I doubt I could afford an MRI at Godley’s clinic. But if others ahead of me can, I say let them get out of the way.

Roos et al. insist that private operators like Godley should not be allowed to expand because a) they will make a profit and b) they will offer diagnostic tests. Research shows, they note, that Canadians already are getting too many unnecessary MRIs and other tests.

That’s an argument for better clinical guidelines, not for preserving wait lists so hospitals alone can deliver meaningless, expensive tests. I don’t look to the American way. I look to Europe, where private/public health systems are the norm. Where, in Sweden, citizens have traded the old and tired sacred cow of monopolistic, publicly administered health for a shiny, efficient private hospital that actually delivers care when needed, not when government says it can provide. If you want to read more on that revolution, e-mail me. I’ll send you a paper on the Swedish experience.

Sweden’s not going to happen here tomorrow. Sigh.

But we could all benefit if government and medicare purists would stop chasing away (or into court) the few daring business types who want to offer a little choice.